IMAGING DIAGNOSIS—IMAGING AND HISTOPATHOLOGIC CHARACTERISTICS OF A VERTEBRAL HAMARTOMA IN A CAT

A 9‐month‐old domestic shorthair cat had progressive ambulatory paraparesis, proprioceptive ataxia, and thoracolumbar hyperesthesia. An extradural mass affecting the left pedicle and lamina of the second lumbar vertebra (L2) causing marked spinal cord impingement was identified in magnetic resonance (MR) images. The mass was predominantly calcified in computed tomographic (CT) images. A hemilaminectomy was performed to resect the mass. Clinical signs were greatly improved at 12‐month follow‐up. The histopathologic diagnosis was vascular hamartoma. To our knowledge, this is the first report describing the MR characteristics of a vascular hamartoma associated with the vertebral column.     

Aberrant right subclavian artery causing megaoesophagus in three cats

Three entire, domestic, shorthair male cats (age range: 3 months to 5 years) were referred because of regurgitation. Megaoesophagus attributable to aberrant right subclavian artery, originating from the aorta at the level of the fourth intercostal space, was diagnosed in all cats using thoracic radiography and CT angiography. One cat had concurrent patent ductus arteriosus with a normal aortic arch. Three‐dimensional volume‐rendered CT images were used to assess the malformations and to plan surgery for the treatment of the vascular anomalies. Different surgical approaches were used in the two kittens. The third cat was not operated. CT angiography is well suited for preoperative planning in cats with aberrant right subclavian artery alone or in combination with other vascular anomalies.     

Nasal vascular hamartoma in a Domestic Shorthair cat

A nasal mass in a Domestic Shorthair cat was causing facial deformity, sneezing and intermittent epistaxis. Biopsy samples obtained previously had been non-diagnostic. Computed tomography images revealed an irregular, contrast-enhancing mass occupying a large portion of the righthand side of the nasal cavity. Previously described criteria for malignancy were not present. A ventral surgical approach combined with temporary, ipsilateral, common carotid arterial occlusion provided excellent access for debulking the lesion and collecting samples for histopathology. A nasal vascular hamartoma was diagnosed and clinical signs resolved postoperatively. This is the first documentation of this abnormality in the cat. Hamartomatous abnormalities should be included on the list of differential diagnoses for feline nasal mass lesions. The prognosis for hamartomatous lesions postoperatively is good, in keeping with their limited propensity for growth after maturity.     

Post-traumatic peripheral arteriovenous fistula manifesting as digital haemorrhages in a cat: diagnosis with contrast-enhanced 3D CT imaging

Arteriovenous fistulae (AVF) are defined as congenital or acquired abnormal direct communications between an artery and a vein leading to abnormal blood circulation. This report describes an unusual manifestation of acquired peripheral AVF in a cat for which the diagnosis was confirmed by computed tomographic (CT) imaging and three-dimensional (3D) reconstruction. A 10-year-old female spayed domestic shorthaired cat was presented with a 2-month history of nonhealing, crusting, erosive and ulcerative skin lesions on the dorsal right forepaw. Severe chewing and biting, but not lameness, had been reported. Systemic abnormalities were not noted. Histopathology revealed increased numbers of thin-walled and slightly grouped vascular profiles in the superficial and mid-dermis, which were often markedly dilated and partially obscured by prominent hyaline deposits. There were a few pyknotic nuclear fragments and haemorrhages in vascular walls as well as multifocal luminal thrombosis with or without recanalization. Differential diagnoses included progressive angiomatosis with trauma or AVF with secondary regional venous hypertension. Computed tomographic images were acquired using a 16-slice Siemens Somotom Sensation CT scanner, and 3D images were created using the Voxar 3D software. Image reconstruction revealed tortuous aberrant vasculature on the medial aspect of the radius and around the carpus compared to normal vascularization on the contralateral limb. These changes were suggestive of the diagnosis of acquired peripheral AVF. The differential diagnosis for localized, nonhealing, haemorrhagic, crusted, erosive or ulcerative distal extremity skin lesions in cats should include acquired AVF, and diagnosis may be confirmed with contrast-enhanced CT imaging.     

Computed tomographic assessment of vascular invasion and resectability of mediastinal masses in dogs and a cat

AIMS: To assess the sensitivity of non-angiographic contrast-enhanced computed tomography (CT) to determine the presence of vascular invasion of cranial mediastinal masses in dogs and a cat, and to evaluate the association between vascular invasion and peri-operative mortality.

METHODS: A retrospective study was conducted on 25 dogs and one cat. CT scans were completed with slices ranging from 2 to 10 mm. CT images were evaluated by a board-certifi ed radiologist blinded to previous diagnoses and surgical fi ndings. Each CT study was evaluated for vascular invasion, defi ned as disruption of the vessel wall and extension of the mass into the vessel lumen. Data retrieved from the surgery reports included surgical approach, whether vascular invasion was present, the surgeon's decision on operability, and post-operative complications.

RESULTS: Computed tomographic evaluation revealed 25/26 masses had no evidence of vascular invasion. During surgical exploration, 10/26 masses were found to invade major regional vasculature; the cranial vena cava (CVC) was the vessel most commonly invaded (7/10 animals), and 4/7 (57%) patients with invasion of the CVC were euthanised or died in the perioperative period, from surgical or disease-related problems, which was signifi cantly higher than patients without vascular invasion (p=0.045).

CONCLUSIONS: Non-angiographic contrast-enhanced CT was signifi cantly less sensitive for detecting vascular invasion of cranial mediastinal masses when compared with surgical evaluation. If the CVC was invaded by a tumour there was a signifi cant risk of death peri-operatively when compared with non-invasive cases.

CLINICAL RELEVANCE: Due to the signifi cantly higher mortality risk associated with invasion of the CVC, a more sensitive method than CT should be investigated to determine vascular invasion of mediastinal masses pre-operatively.     

Cerebellar vascular hamartoma in a British Shorthair cat

Cerebellar vascular hamartoma was diagnosed in a 16-month-old cat following magnetic resonance imaging and incisional biopsy. The clinical features were consistent with the cerebellar site of the lesion accompanied by signs attributable to cerebellar herniation through the foramen magnum and increased intra-cranial pressure. A lesion of this type represents a previously unreported differential diagnosis for central nervous system lesions in young cats.     

Cerebral vascular hamartoma with thrombosis in a dog

A cerebral vascular hamartoma was identified in the frontal lobe, striatum and thalamus of the right side of the brain of a male, 7-year-old Shih Tzu. Histologically, the lesion consisted of thin-walled vessels, which showed various sizes and occasionally contained fibrin thrombi. These vascular walls were composed of a single layer of fibromuscular tissue lined by flat endothelium with various amount of collagen, but devoid of large coat of smooth muscles and elastic tissue. Immunohistochemically, the lining endothelial cells were positive for von Willebrand Factor antibody. Neuropil between the vessels was stained with Klüver-Barrera stain, and positive for synaptophysin and GFAP antibodies. Based on these findings, the lesion was diagnosed as vascular hamartoma, which might resemble venous malformation in humans.     

USE OF COMPUTED TOMOGRAPHY RENAL ANGIOGRAPHY FOR SCREENING FELINE RENAL TRANSPLANT DONORS

Preoperative knowledge of the renal vascular anatomy is important for selection of the appropriate feline renal donor. Intravenous urograms (IVUs) have been performed routinely to screen potential donors at the Veterinary Hospital of the University of Pennsylvania (VHUP), but the vascular phase views lack sufficient detail of the renal vascular anatomy. Computed tomography angiography (CTA), which requires a helical computed tomography (CT) scanner, has been found to provide superior renal vascular anatomic information of prospective human renal donors. The specific aims of this study were as follows: 1) develop the CTA technique for the feline patient; and 2) obtain preliminary information on feline renal vessel anatomy in potential renal donors. Ten healthy, potential feline renal donors were anesthetized and imaged using a third-generation helical CT scanner. The time delay between i.v. contrast medium injection and image acquisition, and other parameters of slice collimation, slice interval, pitch, exposure settings, and reconstruction algorithms were varied to maximize contrast medium opacification of the renal vascular anatomy. Optimal CTA acquisition parameters were determined to be: 1) 10-sec delay post-i.v. bolus of iodinated contrast medium; 2) two serially acquired (corresponding to arterial and venous phases) helical scans through the renal vasculature; 3) pitch of 2 (4 mm/sec patient translation, 2 mm slice collimation); and 4) 120-kVp, 160-mA, and 1-sec exposure settings. Retrospective reconstructed CTA transverse images obtained at a 2-mm slice width and a 1-mm slice interval in combination with two-dimensional reformatted images and three-dimensional reconstructed images were qualitatively evaluated for vascular anatomy; vascular anatomy was confirmed at surgery. Four cats had single renal arteries and veins bilaterally; four cats had double renal veins. One cat had a small accessory artery supplying the caudal pole of the left kidney. One cat had a left renal artery originating from the aorta at a 90 degrees angle with the cranial mesenteric artery. CTA of the feline renal vascular anatomy is feasible, and reconstruction techniques provide excellent anatomic vascular detail. CTA is now used routinely at VHUP to screen all potential feline renal donors.     

Magnetic resonance imaging of a giant frontal hemorrhagic mucocele with intracranial extension in a cat

A 6‐year‐old domestic short‐haired cat was presented with an acute onset of right cortical encephalopathy. Magnetic resonance imaging (MRI) performed 4 days after the onset of clinical signs revealed a lesion originating from the right frontal sinus with intracranial extension and compression of the right frontal lobe. The lesion was T1‐weighted hypointense and T2‐weighted and fluid‐attenuated inversion recovery hyperintense. Signal voids within the lesion were observed on T2* images, consistent with hemorrhage. Peripheral ring enhancement was visible on postcontrast sequences. These features were consistent with a giant hemorrhagic mucocele. To the authors’ knowledge, this is the first report of MRI characteristics of this lesion in a cat.     

A cardiac vascular hamartoma in a calf: Ultrasonographic and pathologic images

A right atrial mass was observed by ultrasound in a 3-month-old red Holstein calf. Differential diagnoses included endocarditis or tumor. Due to the poor prognosis, the calf was euthanized. On gross examination, there was a marked dilation of the right atrium. A round, poorly delineated, 2 cm mass was visualized in the right atrium. Microscopic findings were consistent with a vascular hamartoma.     

Surgical removal of a localised vascular hepatic hamartoma in a dog

A 2-year-old male Labrador Retriever was presented for sudden abdominal distension. Abdominal ultrasonography revealed abundant abdominal fluid and a hepatic mass, which was removed by total lobectomy. Histologic evaluation of the mass supported a vascular hepatic hamartoma. Vascular hamartomas are rare malformations in animals and only two cases have been reported in the dog. This is the first recorded case of a canine vascular hepatic hamartoma treated surgically and having a successful long-term outcome.     

Double aortic arch in a Siamese cat.

A double aortic arch is described in an 8-week-old female Siamese cat. In this case a vascular ring anomaly consistent with a double aortic arch is described in a cat. Stridor and dysphagia were noted in the cat. Radiography showed an esophageal dilation, with constriction at the fifth intercostal space. At necropsy, the esophagus and trachea were constricted at the base of the heart. The cause of the constriction of both the esophagus and trachea was a vascular ring formed by well-developed right and left aortic arches. The ascending aorta divided into two asymmetrical arches. The right aortic arch was larger than the left. The origin of the major arteries from the aortic arches were anomalous.     

Hydrocephalus with visual deficits in a cat

A 22-month-old male Japanese mongrel cat with a history of dysuria and recurrent generalised tonic-clonic seizure was examined by neuro-opthalmological testing and computed tomography (CT). Vision testing revealed narrowing of the visual field in the right eye, and complete visual deficits in the left eye. Pupillary reactions, and motor and sensory function in the eyelids and the eyes were normal. The cat was diagnosed as hydrocephalus by CT examination, because dilation of the right lateral ventricle, and compression of the right temporal and occipital cortices was shown. The etiology of the hydrocephalus was unclear. Although a unilateral lesion of the upper visual pathway was suspected, a complete homonymous hemianopsia was not shown.     

Linear arrector pili muscle hamartoma on the tail of a sphynx cat

Arrector pili muscle (APM) hamartoma is reported in humans and dogs. We describe a linear APM hamartoma in a sphynx cat. The lesion was characterized by multiple nodules distributed linearly along the tail, made of randomly arranged hypertrophic smooth muscles, the size of which tended to wax-and-wane during a one year follow-up.     

Cardiac hamartoma in a young squirrel monkey who died suddenly

A case of cardiac hamartoma in a 2-month-old squirrel monkey is reported. The monkey showed a loss of appetite and died suddenly. Microscopically, an encapsulated nodular lesion was found at the right atrial wall. The lesion consisted of irregularly shaped, slender myocytes intermingled with a few fibroblasts and collagen fibers. Neither nuclear atypia nor inflammatory cell infiltrate was seen. The constituting cells had stratified striations in the cytoplasm and reacted immunohistochemically for desmin, indicating the nature of myocytes. Based on the above findings, a diagnosis of cardiac hamartoma was made. This is the first case of cardiac hamartoma in this species.     

In this issue – March 2010

Topical anaesthesia for castration and tail docking in lambs · Disease surveillance activities for saleyard pigs · Reproductive effects of time on prepartum transition diets in dairy cows · Bovine herpesvirus type 5 in bull semen · Rib osteomyelitis in three foals · Mycobacterium ulcerans in two horses · Nasal vascular hamartoma in a cat     

Ultrasonography and noncontrast computed tomography of medial retropharyngeal lymph nodes in healthy cats

Objective-To determine various measurements of medial retropharyngeal lymph nodes (MRPLNs) in healthy cats via ultrasonography and CT. Animals-45 cats (age range, 2 to 8 years). Procedures-Cats underwent CT of the head and ultrasonography of the cervical region. Various measurements of MRPLNs were obtained, and parenchymal heterogeneity, presence of a hilus, appearance of margins, and attenuation of MRPLNs were determined. Results-Data for 7 cats were excluded because they did not meet inclusion criteria; data for 38 cats were evaluated. Measurements of left and right MRPLNs were not significantly different. Mean length × rostral height × rostral width dimensions of MRPLNs were 20.7 × 12.4 × 3.7 mm and 20.7 × 13.1 × 4.7 mm in ultrasonographic and CT images, respectively. Maximum MRPLN dimensions were approximately 32 × 20 × 7 mm. Mean attenuation of MRPLNs was 40.2 Hounsfield units. Parenchyma of MRPLNs was mildly (via CT) to moderately (via ultrasonography) heterogeneous. A hilus was identified in 95% (via ultrasonography) and 24% or 92% (via CT [depending on criteria used to define a hilus]) of MPRLNs. Lymph node margins were smooth in CT images and mildly irregular in ultrasonographic images. A negative linear correlation was detected between age of cat and MRPLN volume. Conclusions and Clinical Relevance-MRPLNs in cats were easily imaged via ultrasonography and CT. Left and right MRPLNs were symmetric, and MRPLNs were larger in young adult cats versus old cats. Data were intended to serve as references for evaluation of MRPLNs in healthy cats.     

COMPARISON BETWEEN COMPUTED TOMOGRAPHY AND 99m TC‐ PERTECHNETATE SCINTIGRAPHY CHARACTERISTICS OF THE THYROID GLAND IN CATS WITH HYPERTHYROIDISM

Scintigraphy is currently the reference standard for diagnosing feline hyperthyroidism; however, computed tomography (CT) is more widely available in veterinary practice. The purposes of this prospective study were to describe the CT appearance of thyroid glands in cats with hyperthyroidism and compare CT findings with findings from ^99mTc–pertechnetate scintigraphy. Twenty‐five adult hyperthyroid cats were included. Plain CT images were acquired for each cat and the following characteristics recorded for each thyroid lobe: visibility, delineation, position, attenuation, shape, and subjective size. Scintigraphic images were also acquired and the following characteristics recorded: radiopharmaceutical uptake, delineation, ectopic foci, shape, and subjective size. In CT images, thyroid lobes were most commonly found between the second and fourth cervical vertebrae, dorsolateral to the trachea. Affected thyroid lobes (based on scintigraphy reference standard) were most commonly oval and moderately enlarged in CT images. A heterogeneous attenuation pattern (isoattenuating to adjacent soft tissues with hypo‐ and hyperattenuating foci) was most commonly found in affected thyroid lobes. A positive correlation (P < 0.01) was identified between CT and scintigraphy for left‐to‐right thyroid lobe size relationship and subjective size of the larger thyroid lobe. The CT estimated mass was significantly higher (median = 148.8; range = [0;357.6]) for the more active thyroid lobe compared to the less active thyroid lobe (median = 84.6; range = [0;312.3]); (W = 154; P < 0.01). Findings indicated that CT may not reliably differentiate unilateral vs. bilateral hyperthyroidism in cats; however, CT may be a reliable alternative test for correctly identifying the more active thyroid lobe.     

CROSSED RENAL ECTOPIA WITH FUSION IN A CAT

In humans, crossed renal ectopia is a rare, usually asymptomatic, congenital malpositioning of the kidneys, involving wandering of one or both embryonic kidneys across the midline and usually fusion with its contralateral partner. This is the first report of crossed renal ectopia in the cat. A 7-year-old, neutered male cat was presented with polyuria, polydipsia, and a palpable abdominal mass. Diagnostic investigations, including clinical pathology, survey and contrast radiography, and ultrasonography, confirmed the presence of an ectopic left kidney fused with an orthotopic right kidney, with concurrent renal failure and hypertension. Many features of crossed renal ectopia in this cat are similar to those described in humans, however the vascular supply, the presence of renal failure, and the axial rotation of the fused kidney are atypical.     

Surgical management of a cat with hepatic arterioportal fistula

A 9‐month‐old domestic short‐haired cat presented with stunted growth and chronic gastrointestinal signs. Tachypnoea, a heart murmur and cranial abdominal bruit were detected on physical examination. Echocardiography revealed volume overload in all heart chambers. CT angiography identified an abnormal communication between the hepatic arterial circulation and the portal vein, along with multiple acquired shunts. The abnormal vascular communication was surgically ligated. Echocardiography documented improvement in cardiac parameters following surgery and the cat continues to have no clinical signs 39 months after surgery. This report describes successful surgical management of feline hepatic arterioportal fistula for the first time.